Dr. Minami: An earlier study by our group demonstrated a seemingly paradoxical relationship between hospital quality and hospital penalization in the Hospital-Acquired Condition, or HAC, Reduction Program. Basically, of those hospitals that were penalized more frequently were those that were major teaching hospitals, had more quality accreditations, and had better performance on process and outcome measures. When CMS released that surgical-site infections were going to be added to the HAC scoring, we decided to see if these additional measures might exhibit the same paradoxical association between quality and penalization.

MedicalResearch.com: What are the main findings?

Dr. Minami: The SSI measures follow the same trend as was previously illustrated. Basically, the hospitals who were in the bottom 25% (that is, those who were the worst performers) were more often those that were major teaching hospitals, with more quality accreditations, and offered more advanced services. It’s possible that this is due in part to surveillance bias, or “the more you look, the more you find” phenomenon. Also, what do we really call an infection? The National Healthcare Safety Network has specific definitions and guidelines, but there are still different data collections used by different hospitals.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Minami: While measuring quality is of paramount importance, we really have to be sure that we’re getting the measurements right. So just because a hospital is a “poor-performer” by the HAC Reduction Program or on the SSI measure, doesn’t necessarily speak to its quality of care. This is an example of how quality measure refinement has to be an ongoing process and how difficult it is to really get it right.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Minami: We need to dig deeper in terms of getting these programs right. In SSI specifically, making sure our infection surveillance and our data abstraction standards are consistent across the nation is important. Formal auditing programs may be one way to make sure that everyone is coding their data in the same way. And as with a lot of quality measures, it’s important to focus on getting the risk-adjustment right—that is, making sure that we’re taking into account the relevant patient and procedural details to keep from penalizing a hospital just because it’s taking care of sicker patients.

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